Provider Demographics
NPI:1619605938
Name:PRUSKI, LANA LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:LYNNE
Last Name:PRUSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:830-393-8222
Mailing Address - Fax:844-212-0399
Practice Address - Street 1:260 US HIGHWAY 181 N
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3136
Practice Address - Country:US
Practice Address - Phone:830-393-8222
Practice Address - Fax:844-212-0399
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant